Post on 22-Jan-2016
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Immunisation Update
Afua Nketia, Immunisation Coordinator
Dr Agnes Marossy, Consultant in Public Health
Immunisation
Immunisation is one of the most effective public health interventions.
The World Health Organisation recommend that uptake for childhood immunisations should be at least 95%.
We are not achieving this target.
Why are we not achieving the target? Not enough people being immunised We don’t always have a record even if
someone has been immunised
Why are people not immunised?
Lack of knowledge- Schedule changes- second dose MMR,
12 mth baby immunisations Misinformation - Wakefield Misunderstanding of when immunisations are due -
pre-school booster Lack of access-hard to reach, language problems,
migration, chaotic lifestyles Cultural reasons
Why don’t we know who has been immunised?
Good question!
Why don’t we know who has been immunised? Before 2010
1. Paper records not sent / never arrived in post
2. Child moved out of area and records sent away
3. Immunisations missed elsewhere not entered on child’s record
After 2010
1. Immunisations on practice system not always entered on the correct template. Sometimes deleted by accident
2. Wrong date of birth, name or other demographic details
2 and 3 from “before 2010”.
Bromley position 2008-9
Immunisation Actual 2008-2009
Trajectories 2010- 2011
DPT at age 1 year 75.5% 90%
PCV booster at age 2 yrs
75.4% 90%
Hib/MenC booster at age 2yrs years
82.2% 95%
MMR 1st dose at age 2 years
82.2% 90%
DTaP/IPV booster at age 5 yrs
74.3% 95%
MMR booster at age 5 yrs
71.1% 90%
Bromley position 2011-12
Immunisation
Actual 2011-2012
Trajectories 2010-11
DPT at age 1 year 95.1% 90%
PCV booster at age 2 yrs
90.0% 90%
Hib/MenC booster at age 2yrs years
91.9% 95%
MMR 1st dose at age 2 years
91.5% 90%
DTaP/IPV booster at age 5 yrs
87.6% 95%
MMR booster at age 5 yrs
88.5% 90%
Trends in uptake
Immunisation Trends
50.00%
55.00%60.00%
65.00%70.00%
75.00%
80.00%85.00%
90.00%95.00%
100.00%
1yr
DT
aP
/IPV
/Hib
2 yr P
CV
Bo
oste
r
2yr H
ib/M
en
CB
oo
ster
2yrs M
MR
1
5yr D
Ta
P/IP
V
5yr M
MR
2
Actual 2008-09 Actual 2009-10 Actual 2010-11
Actual 2011-12 Trajectories 2010-11
What have we done to improve……
Knowledge Awareness of the schedule, posters, leaflets Nursery visits Glades adverts
Access Defaulter project Misinformation- national approach Cultural- gypsy traveller work Data quality work. (collection and training)
Defaulter project
Better data- better analysis of individual practice data Training all practices to run timely searches Defaulter project introduced. Health visitors and
practice working together in targeting defaulters. This exercise highlighted the health visitor role in childhood immunisations.
Evaluation of defaulter project indicated a need to change the process-
Improving immunisation uptake was piloted following the defaulter project evaluation.
Nursery Projects
All Bromley nurseries asked to take part in survey about childhood immunisations
5 nurseries agreed to hold coffee mornings to raise awareness of childhood immunisations.
Parents were invited to bring their children’s Red books, to the coffee mornings where a gift was offered to completely immunised children.
Nursery project findings
Some parents were unsure what immunisations their children had. The extra MMR in 2008/9 was especially confusing to most parents.
Most thought the pre-school booster meant just that.
Improving immunisation project
30 practices in Bromley were included in the improving immunisation project. A snapshot of defaulting children in these practices were targeted by the Public health team.
Steps- team member contacts practice to check if child has been
immunised or has an appointment. Where required team member contacted the guardian by phone.
When appointment booked, option of a text reminder was given. Where no response to phone calls (9) a home visit was made Active refusers had the immunisation record changed to reflect
this.
Improving immunisation project evaluation The use of prewritten script and text
message reminder successful. Home visits took up more time than
expected and there was a lower response rate.
Improving immunisation project what next 37.84% of the defaulter children had previous
immunisations but no record on the GP data base. ? Encourage practices to implement the processes used.
Non medical staff could make the telephone call with the aid of the prewritten script.
Encourage practices to use text reminders- many already do.
Good practice findings to be circulated to practices.
Pathway for unregistered children with incomplete immunisation history
Unregistered children
Data analyst to run report on immunisations for appropriate quarter. Search to be for all children in the cohort aged 6 months, 16months and
4 years who are unregistered and have missing immunisations. Information to include NHS number, RiO number, team and HCP if
known
Child health to check RiO system to ascertain if missing result due to unsynchronised record and run
registration checks
If GP still unknown, child health to notify appropriate team/HV of missing immunisation on child with unknown GP
HV to try and contact family to find out GP registration and remind re immunisation. If no GP to advise parent to register child
HV to record in RiO progress notes outcome of contact.
If HV was unable to contact, to record this in the progress note and action to be taken
as per HV Service Visiting New Clients Procedure. If no longer living at address to
inform child health address unknown
If child has had the outstanding immunisation HV to inform child health manager date and immunisation given
Child health manager to input immunisation on RiO
If no GP at time of contact with parent, HV to check RiO 4 weeks after contact to check child has been registered. If still not registered to follow up as per HV Service New Clients Procedure.
Unregistered children Data analyst to run report on
immunisations for appropriate quarter and also for all children in the above cohort
aged 6 months, 16months and 4 years who are unregistered and have
missing immunisations This means two different searches are
being done
Commissioning for Quality and Innovation (CQUIN) payment
Immunisation uptake at 5 years
Immunisation uptake at 2 years
Immunisations uptake at 1 year
Thank you for your attention.
Any questions?